Please do not stop the circumcision!

Most doctors would not attemp a circumcision on these patients with obvious hypospadias/chordee:

However, if you start a circumcision because the penis looked normal at the beginning, please don’t stop!

If you think you found hypospadias during the circumcision there are 2 possible scenarios:

Scenario 1 (the most common one): The child does not have hypospadias, just needs to have all the ventral adhesions and frenulum released. If you stop the circumcision, some pediatric urologist (but not all) will be able to complete the circumcision in the office under local anesthesia a few days later. If your pediatric urologist does not do circumcisions under local anesthesia, then the child will be getting a circumcision revision under general anesthesia.

Why were you taught to stop circumcisions in cases of MIP hypospadias

Before 1994, the most common surgical technique used to repair hypospadias required an intact penis and was not feasible after circumcisions (Mathieu repair).

I would recommend asking your referring pediatric urologist what kind of repair he uses for distal hypospadias and if it would be ok for you to complete circumcisions. If you get pushback, send him/her this paper. My answer has always been: “please do not stop!! The hypospadias repair is actually easier if the circumcision is already done. ”

Conclusion

If the foreskin looks completely normal before the start of the circumcision: complete the circumcision.

If the foreskin looks abnormal before the start of the circumcision: do not attempt the circumcision and refer the patient.

Like anything in medicine, the above are general guidelines, so use good judgment on a case to case basis.